eMedicine Specialties > Dermatology > Benign Neoplasms
Halo Nevus: Differential Diagnoses & Workup
Updated: May 28, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Differential Diagnoses
| Atypical Mole (Dysplastic Nevus) | Molluscum Contagiosum |
| Basal Cell Carcinoma | Pityriasis Lichenoides |
| Lichen Planus | Spitz Nevus |
| Lichen Sclerosus et Atrophicus | Vitiligo |
| Malignant Melanoma |
Other Problems to Be Considered
Dysplastic nevus
Hypopigmented sarcoidosis
Verruca plana
Sunscreen application8
Workup
Other Tests
Performing an examination using a Wood lamp may aid in differentiating halo nevi from other disorders.
Procedures
Lesions that are not uniform in shape and color or that have a papular component that is not centrally located should be considered for biopsy to exclude the presence of melanocytic atypia.
Histologic Findings
The histology of halo nevus is variable depending on the age of the lesion; however, in most cases, a dense, somewhat bandlike lymphocytic infiltrate is present in the papillary and often reticular dermis with nests of nevus cells located centrally. The lesion usually demonstrates a dome-shaped architecture similar to that seen in noninflamed nevi. Identifying residual nevus cells may be difficult in some cases, particularly with older lesions or those in which the infiltrate is quite dense. Mitotic figures usually are not seen, although occasional apoptotic cells may be identified. Macrophages may be seen within the infiltrate, some of which are laden with melanin, although, surprisingly, the number of melanophages is less than would be expected in an inflamed melanocytic lesion.
At low magnification, a dome-shaped papular lesion reveals a dense infiltrate of lymphocytes in the dermis (hematoxylin and eosin, original magnification X40).
Higher magnification reveals nests of nevus cells with numerous lymphocytes surrounding them and in the interstitium (hematoxylin and eosin, original magnification X40).
In more mature lesions, nevus cells may appear to be absent or decreased in number. Clinically, a noninflammatory halo nevus may demonstrate a halo, but, histologically, virtually no inflammatory infiltrate may be present. Conversely, some nevi may demonstrate marked inflammation, but, clinically, no halo is visible. Therefore, clinical correlation is important in rendering a diagnosis of halo nevus. The most important lesion to differentiate from halo nevus is melanoma (see Table).
Distinguishing Features of Halo Nevus and Melanoma
Open table in new window
Table
| Halo Nevus | Melanoma |
|---|---|
| Nevus cells in nests | Single atypical melanocytes at all levels of the epidermis and aggregates of atypical melanocytes in the dermis |
| Lesion symmetrical | Lesion asymmetrical |
| Maturation of nevus cells | Lack of maturation |
| Mitotic figures rare or absent | Mitotic figures present |
| Lymphocytic infiltrate present diffusely throughout lesion | Lymphocytic infiltrate tends to be at be concentrated at periphery |
| Halo Nevus | Melanoma |
|---|---|
| Nevus cells in nests | Single atypical melanocytes at all levels of the epidermis and aggregates of atypical melanocytes in the dermis |
| Lesion symmetrical | Lesion asymmetrical |
| Maturation of nevus cells | Lack of maturation |
| Mitotic figures rare or absent | Mitotic figures present |
| Lymphocytic infiltrate present diffusely throughout lesion | Lymphocytic infiltrate tends to be at be concentrated at periphery |
More on Halo Nevus |
| Overview: Halo Nevus |
 Differential Diagnoses & Workup: Halo Nevus |
| Treatment & Medication: Halo Nevus |
| Follow-up: Halo Nevus |
| Multimedia: Halo Nevus |
| References |
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References
Happle R. [Grunewald nevus]. Hautarzt. Dec 1994;45(12):882-3. [Medline].
Zeff RA, Freitag A, Grin CM, Grant-Kels JM. The immune response in halo nevi. J Am Acad Dermatol. Oct 1997;37(4):620-4. [Medline].
Patrizi A, Neri I, Sabattini E, Rizzoli L, Misciali C. Unusual inflammatory and hyperkeratotic halo naevus in children. Br J Dermatol. Feb 2005;152(2):357-60. [Medline].
Fishman HC. Letter: Malignant melanoma arising with two halo nevi. Arch Dermatol. Mar 1976;112(3):407-8. [Medline].
Jacobs JB, Edelstein LM, Snyder LM, Fortier N. Ultrastructural evidence for destruction in the halo nevus. Cancer Res. Feb 1975;35(2):352-7. [Medline].
Herd RM, Hunter JA. Familial halo naevi. Clin Exp Dermatol. Mar 1998;23(2):68-9. [Medline].
Brazzelli V, Larizza D, Martinetti M, et al. Halo nevus, rather than vitiligo, is a typical dermatologic finding of turner's syndrome: clinical, genetic, and immunogenetic study in 72 patients. J Am Acad Dermatol. Sep 2004;51(3):354-8. [Medline].
Zalaudek I, Moscarella E, Argenziano G. Artifactual "pseudo-halo nevi" secondary to sunscreen application. J Am Acad Dermatol. Jun 2006;54(6):1106-7. [Medline].
Berg P, Lindelof B. Differences in malignant melanoma between children and adolescents. A 35-year epidemiological study. Arch Dermatol. Mar 1997;133(3):295-7. [Medline].
Further Reading
Keywords
halo nevus, nevus of Sutton, halo nevi, Sutton nevus, Sutton nevi, melanoma, malignant melanoma
